title: Clinical remission following endoscopic placement of retrievable, fully covered metal stents in patients with esophageal achalasia.
abstract: Metal stents may represent an alternative therapy in the treatment of achalasia. We therefore evaluated the effectiveness of retrievable, fully covered metal stents in patients with achalasia. Fifty-nine patients with achalasia were treated with retrievable, fully covered metal stents. Symptoms using a global symptom score (0-10), lower esophageal sphincter (LES) resting pressure, LES relaxation, and simultaneous contraction of the esophagus were analyzed before and 1 week and 1 month after intervention. Complications and treatment outcomes were followed up at 6, 12, 18, and 24 months postoperatively. Stent placement was successful, and clinical symptoms resolved (P < 0.01) in all patients. Regurgitation, dysphagia and chest pain improved significantly (all P < 0.01). Therapy improved LES resting pressure (51.4 ± 9.7 mmHg pretherapy vs. 20.9 ± 8.1 mmHg post-therapy), LES relaxation (58.1 ± 17.1% pretherapy vs. 84.5 ± 18.9% post-therapy), and simultaneous contraction of the esophagus (36.1 ± 8.6% pretherapy vs. 69.4 ± 23.1% post-therapy) 1 month after stent placement (all P < 0.01). The cumulative clinical remission rates 6, 12, 18, 24, 30, and 36 months after stent removal were 90.9%, 81.8%, 76.4%, 69.1%, 65.5%, and 49.1%, respectively. All patients tolerated stent placement. Twelve patients (25.5%) complained of substernal pain and five (10.6%) had substernal burning. Stents migrated in four patients (8.5%). Insertion of retrievable, fully covered metal stents is an effective and safe treatment in patients with achalasia.
authors.affiliation: Department of Gastroenterology, Shanghai First People's Hospital, School of Medicine, Shanghai Jiaog Tong University, Shanghai, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Zeng
authors.forename: Y-M
authors.initials: YM
authors.lastname: Dai
authors.forename: X-J
authors.initials: XJ
authors.lastname: Wan
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003680:Deglutition Disorders / Q000209:etiology / Q000601:surgery*; D004931:Esophageal Achalasia / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008365:Manometry; D008670:Metals; D008875:Middle Aged; D011446:Prospective Studies; D011475:Prosthesis Failure; D012074:Remission Induction / Q000379:methods; D015607:Stents; D016896:Treatment Outcome
chemical_list: D008670:Metals
keywords: achalasia; clinical remission; retrievable fully covered metal stent